April 08, 2006

AIDS in Africa Systematically Overstated

I've never doubted that AIDS is a problem very much in need of tackling in the developing world, including in Africa, but for nearly two decades now we've been bombarded with reports suggesting that virtually 1 in every 3 men, women and children living south of the Sahara desert was an HIV carrier, giving rise to all sorts of daft theories by so-called "race realists" and even supposedly sober economists about the wayward sexual proclivities of black Africans; now comes evidence from a credible source that the statistics which gave birth to all this armchair theorizing have been drastically inflated.

KIGALI, Rwanda -- Researchers said nearly two decades ago that this tiny country was part of an AIDS Belt stretching across the midsection of Africa, a place so infected with a new, incurable disease that, in the hardest-hit places, one in three working-age adults were already doomed to die of it.

But AIDS deaths on the predicted scale never arrived here, government health officials say. A new national study illustrates why: The rate of HIV infection among Rwandans ages 15 to 49 is 3 percent, according to the study, enough to qualify as a major health problem but not nearly the national catastrophe once predicted.

The new data suggest the rate never reached the 30 percent estimated by some early researchers, nor the nearly 13 percent given by the United Nations in 1998.

First, some reading for those inclined to buy into the "Africa as one big, undifferentiated, hopelessly diseased continent" lovingly, insistently peddled even by "liberal" outlets like the contemptible New York Times.

The study and similar ones in 15 other countries have shed new light on the disease across Africa. Relying on the latest measurement tools, they portray an epidemic that is more female and more urban than previously believed, one that has begun to ebb in much of East Africa and has failed to take off as predicted in most of West Africa.

Yet the disease is devastating southern Africa, according to the data. It is in that region alone -- in countries including South Africa, Botswana, Swaziland and Zimbabwe -- that an AIDS Belt exists, the researchers say. (emphasis added)

Got that? All African peoples aren't the same, and they aren't all about to start dropping like flies as a result of "dry sex", uncontrollable promiscuity or whatever other nonsense to which a supposed continent-wide pandemic has been attributed in the past.

... by 2002, disparities were already emerging. A national study in the southern African country of Zambia, for example, found a rate of 15.6 percent, significantly lower than the U.N. rate of 21.5 percent. In Burundi, which borders Rwanda in central East Africa, a national study found a rate of 5.4 percent, not the 8.3 percent estimated by UNAIDS.

In West Africa, Sierra Leone, just then emerging from a devastating civil war, was found to have a national prevalence rate of less than 1 percent -- compared with an estimated U.N. rate of 7 percent. (emph. added)

Even a rate of 0.5 percent would still be too high for my liking - the ideal rate being zero - but the fact is that this figure suggests Sierra Leone's AIDS rate is actually lower than Russia's, once the disparity between official and unofficial figures in the latter country are taken into account, and it's also a safe bet that the figures for many parts of India are also higher than this, yet the media and the NGO types would have one think AIDS were an exclusively black African problem; for a lot of people the world over, it's just so much easier to believe that those "dirty", "savage", "oversexed" blacks are the only ones who are at any real risk of contracting AIDS, just as they're the only ones who ever suffer famine (and as we know, all African children are just a step away from dying of hunger), rather than accepting that there are serious health problems brewing in their own backyards. The featureless, uniform "Africa" of popular imagination is the canvas on which others feel free to paint their images of native sin and externally-derived redemption.

As for what makes the difference between southern Africa and the rest of the continent, my best guess is that it comes down to two causes: one is the disparity in circumcision rates between the region and in countries further north - it has now been established beyond all reasonable doubt that circumcision dramatically lowers HIV transmission rates - and the second being the system used by the South African government to manage black migrant workers during the apartheid years. It doesn't take a genius to see how crowding hundreds of thousands of unaccompanied males into single-sex hostels, and preventing them from seeking any forms of leisure other than those to be found in the whorehouse and the shebeen, could have fueled an STD epidemic, especially when one of the vectors in question was a virus with such a long lead time between infection and manifestation, but that is just what the apartheid government did, and the best evidence for this argument is that the labor-management institutions which were established in that era are still at work today spreading HIV far and wide. Of course, it doesn't help matters in southern Africa that the key leaders in the region are either murderous tyrants more concerned with looting and staying in office than petty matters like AIDS, conspiracy-minded fruitcakes inclined to dispute the causative influence of HIV, or crooked rapist dolts who subscribe to the ridiculous notion that showering makes it safe to sexually assault HIV-positive women.

Comments

Simply brilliant. Though The Village Voice blew the cover off of this many years back. Its interesting isnt it; how you meet so many West Africans and some of them express skepticism about AIDS and you ask why and they are like "We just dont see anybody dying of AIDS" (The same response is given to Poverty and Famine btw). Not minding the potentially lackadaisical attitude this conveys, it has always served to illustrate to me that the AIDS crises of popular media imagination was predominantly a race problem - where blacks and gays were held as scapegoats by the West, due primarily, to their voicelessnes. Once the race rea"lie"sts jumped on it though, it was game over.
This meme has spread far and wide, with popular stereotypes of the JIV infected black boyfriend now permanent fixtures in the far East and in several Scandinavian countries, despite the relatively low black populations of these areas.
Furthermore, the key issue here is the urban nature of the disease - a problem directly tied to the rural migrations of post independence and the resulting urban poverty - which drove many into promiscuous lifestyles: Reverse migration to the rural areas completed the cycle.
The sad thing of course, is how racial bias never factors into the supposed self examination that much of the Media purports to hold in such high esteem. The question of "Why" such high estimates were reported doesnt appear in the WaPo story, Neither is it appearing on the PBS documentary on AIDS: This will turn out to be just another media event dumped into the trash bin of History (much like Super Soviet Russia of cold war years); with the attendant policy and public damages inflicted left unaccounted for.

PS:
So after I typed my comment, I shuffled over to Technorati and made a round up of the blogs covering this. As I expected, I found no mention of the Racial Bias inherent in driving this story all along. Even Bryan Caplan who had some good things to say made no mention of how bias against gays and homosexuals drove this media event; preferring instead to talk about "credibility" and "protection" - as though the credibility researchers were trying so hard to protect wasnt itself hinged on some perverse social narrative about "out groups".
Or how condescension and pretensions to intellectual superiority caused the media to fail to listen to the many African voices who warned right from the start that the issue was being overstated - until those voices were themselves co-opted by the UN and the Western narrative.

You know whats bad? This will provide ammunition to the denialists - and perhaps the world will finally get the Real African AIDS Crisis (TM) that is has been desiring all along. Absolutely pathetic.

"blacks and gays were held as scapegoats by the West, due primarily, to their voicelessnes."

But wasn't it largely gay organisations that were promoting the idea of an imminent Aids epidemic in the West during the 1980s? When it failed to materialise people switched to Africa as the object of the doom mongering.

When I read the Washington Post article it reminded me of something I saw a couple of years ago by a South African called Rian Malan, who was pointing out that the epidemilogical estimates of Aids rates in Africa were contradicted by most statistics that relied on actually testing people rather than computer models. For example BBC asserted that ‘one in seven’ Malawian teachers would die in 2002 alone.' The total death rate for the group was actually under 3%. The Spectator had claimed that "Botswana may soon become the first nation in modern times literally to die out." It is actually growing at 2.7% per annum. I have to admit when I first read it I assumed he was a crank, but he appears to be vindicated.

The column is reproduced here, (it originally appeared in the Spectator) http://www.lewrockwell.com/spectator/spec192.html

I noticed this (again) when I saw 'The Interpreter' last year - when they introduced Matobo for the first time, they displayed the text "Matobo, Africa" as if Africa were a country and as if to invoke the image of the featureless 'heart of darkness' Africa. You'd never see that with made-up countries on other continents, like "Molvania, Europe"...

I recall posting on this subject a couple of years ago - see here: http://www.gnxp.com/MT2/archives/001473.html

But it's very difficult to get at the truth on such matters. In my post I argued that some people have a vested interest in overstating the incidence of AIDS, but equally, some people (e.g. some African Governments) may have an interest in playing it down.

[...But wasn't it largely gay organisations that were promoting the idea of an imminent Aids epidemic in the West during the 1980s...]

I am referring to the stereotyping of the disease here. The voices of gay AIDS activists did nothing to stop discussions about the "Gay Plague" as recently as the 1990s and I believe last year, I saw an article by Micheal Fumento (The Myth of Heterosexual AIDS) on Frontpage - arguing, amongst other things, that the spread of AIDS even in Africa was the result of homosexuality (and then he tries to debunk the "Africans arent Homosexuals" meme and ascribe a significant aspect of the cause of the epidemic to African gays all in a couple of sentences). So you can see, that even in the 21st century - regardless of how many gay and African AIDS activists there are; powerful themes still run through the West which stereotype the disease - which was basically my contention. Indeed, the heavy presence of gays and Africans among activists might only reinforce these stereotypes in the minds of certain persons...

[...they displayed the text "Matobo, Africa"...]

Ah Yes...The "Africa is a country and Nelson Mandela is its President" meme. This one pops up in countless ways, "Lagos, Africa", "Accra, Africa" - but notice, it is never "Cairo, Africa", hardly "Tripoli, Africa", or even "Cape Town, Africa". Yesssssssssss, I wonder why? You might recollect in Kill Bill (Vol 2) where the one eyed lady goes on about a snake in Africa (yes, the magic word again) and then she says something like "the natives of Africa say...this has been true in Africa since the beginning of time."

@ David B:

Hmm, the post doesnt say anything about African governments playing down the crisis. Though I must say, with the money now coming in, it seems African governments would be interested in overstating the crisis. Its not as difficult to get the truth as it seems; no one seems to have a problem with observing or modeling Malaria for instance.

"Its not as difficult to get the truth as it seems; no one seems to have a problem with observing or modeling Malaria for instance."

I thought this was because it's obvious when someone has malaria, or at least more so than with HIV - if you have malaria, you're obviously sick and you're likely to go to the doctor (if there is one), whereas with HIV you'll have no symptoms for many years.

[...if you have malaria, you're obviously sick and you're likely to go to the doctor...]

From the WaPo story: The AIDS models were drawn from prenatal clinic tests. And there is a paucity of Doctors in rural areas vis-a-vis malaria. Besides, there is a fallacy here: If HIV werent so obvious, and this was the modeling problem; then the epidemic should have been *understated* not *overblown*, right? Some people wanted an epidemic and when Africans werent delivering one quickly enough, they just turned around and invented it themselves.

"If HIV werent so obvious, and this was the modeling problem; then the epidemic should have been *understated* not *overblown*, right"

Well not necessarily - the modelers probably figured that HIV would be under-reported because of lack of symptoms, stigma, refusal to be tested, and thus compensated - as it turns out overcompensated - for those factors. Of course this assumption (like the assumption that HIV+ rates would be similar in rural villages as in urban young women) is itself based, consciously or unconsciously, on the assumption that the HIV epidemic must be huge...

My comment on African governments maybe playing down the problem was partly with South Africa in mind. Haven't SA politicians been reluctant to acknowledge the scale of AIDS, because they don't want to pay for the necessary drugs? Or am I confusing it with a reluctance to accept HIV as the cause of AIDS? Didn't Mbeki give comfort to the Duisberg heresy? Apologies if I'm misremembering all this...

Incidentally, on the subject of circumcision, I doubt that it gives *much* protection. The USA, where most men are circumcised, has higher HIV incidence than Western Europe, where most men are not. And in South Africa, if I recall correctly, the main ethnic group has its boys circumcised around puberty. It would be unwise to give the impression that you can get circumcised and then not worry about infection!

"Incidentally, on the subject of circumcision, I doubt that it gives *much* protection"

Why don't you just read the PLoS study then, or browse through the many others on PubMed?

"The USA, where most men are circumcised, has higher HIV incidence than Western Europe, where most men are not."

As if this establishes anything. One would think you'd never taken a statistics class, seeing such naive reasoning.

"And in South Africa, if I recall correctly, the main ethnic group has its boys circumcised around puberty."

If you'd done your homework you'd know that the uncircumcised Zulu groups have a much higher HIV incidence rate than the circumcised Xhosa.

"It would be unwise to give the impression that you can get circumcised and then not worry about infection!"

And who exactly are the individuals going about doing any such thing? I suggest you better inform yourself of the realities of the debate surrounding the issue rather than relying on your vague and clearly flawed impressions.

>> "The USA, where most men are circumcised, has higher HIV incidence than Western Europe, where most men are not."

As if this establishes anything. One would think you'd never taken a statistics class, seeing such naive reasoning.

"And in South Africa, if I recall correctly, the main ethnic group has its boys circumcised around puberty."

If you'd done your homework you'd know that the uncircumcised Zulu groups have a much higher HIV incidence rate than the circumcised Xhosa. <<

-- Well, hoity-toity! You accuse me of statistical naivety, then two sentences later use *exactly* the same 'naive' reasoning! What the US/Europe contrast does prove (and what I used it to prove) is that circumcision, by itself, gives little protection against HIV. And since it gives little protection, it is irresponsible to advocate it as a major anti-HIV precaution. This can only give 'naive' reasoners (i.e. most of the world's population) the impression that if they are circumcised they don't need to wear a condom.

"1 in 3? I don't remember that. A "high" proportion, yes, and talk of proportions that high in the AIDS belt countries of southern Africa. That proportion, no."

My my, we're a little too literal-minded today, aren't we? Ever heard of rhetorical hyperbole? Are you going to accuse me of error the next time I say "Everybody and his brother is claiming X"?

"You accuse me of statistical naivety, then two sentences later use *exactly* the same 'naive' reasoning!"

By god, that's stupid! You made two claims as "proof" for something, and I offered two easily found pieces of evidence you were ignorant of to show how unfounded your absurd claims were. You said HIV rates didn't differ between circumcised and uncirmcumcised South Africans, and the fact is that you were as wrong in your claim as it is possible to be. What I was trying to establish was just how profound your ignorance was, not trying to duplicate the PLoS study in a blog comment, and your red herring here can't obscure the fact that my aim was quite clearly achieved: you were (and likely still are) speaking from a position of ignorance.

"What the US/Europe contrast does prove (and what I used it to prove) is that circumcision, by itself, gives little protection against HIV."

It "proves" nothing of the sort - that's what studies of the kind published in PLoS are for. It's the height of statistical stupidity to ignore possible differences in behavior and background when making comparisons of the sort you're trying to: you might as well say that smoking doesn't cause cancer because nonsmokers in a concentration camp die as soon as smokers.

"And since it gives little protection, it is irresponsible to advocate it as a major anti-HIV precaution. "

"Are you going to accuse me of error the next time I say 'Everybody and his brother is claiming X'?"

If they aren't claiming X, sure. I haven't heard any claims at all suggesting that one-third of the population of sub-Saharan Africa was HIV positive. I haven't heard of anyone reputable who _has_ claimed this.

This doesn't contradict your central point, that rates of HIV seropositivity have been overestimated throughout most of Africa, in many cases wildly overestimated. I don't disagree with your point. I just think you overreached with your rhetoric. Call my objection something aesthetic, if you'd like.

Do you actually believe the goverments of Africa keep a acturate count of Hiv-Aids stats ?
When 1 of 3 Africans die of Aids, it is generally told the person died of TB , Malaria, ect ect.
This is true because the person did not actually die of Aids, they died of some opportunistic disease.

"When 1 of 3 Africans die of Aids, it is generally told the person died of TB , Malaria, ect ect."

And how did YOU come up with your "1 of 3 Africans" figure, seeing as you claim African governments don't have such statistics? Are you trying to say you're the only one in the world who "really knows" the truth?